THE DOCTOR IS IN: OVERHAULING AN ED ADMISSION PROCESS TO EMPHASIZE THE INITIAL PHYSICIAN-PATIENT ENCOUNTER

Evangelos Loukas, D.O.*1;Linda M Kurian, M.D.2;Charles L Kast, M.D.1;Dr. Kenneth Feldhamer, MD3;Corey D Karlin, MD4 and Lawrence Belletti, M.D.1, (1)Hofstra Northwell School of Medicine, North Shore University Hospital, Manhasset, NY, (2)Hofstra Northwell School of Medicine, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, NY, (3)Hofstra North Shore-LIJ School of Medicine, North Shore University Hospital, Manhasset, NY, (4)Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 186

Categories: Innovations Abstracts, Quality Improvement

Keywords:

Background: Patients often must wait several hours before being seen by an admitting attending physician. Protracted admit wait times are undeniably associated with delays in care, patient and family dissatisfaction, and very likely increased lengths of stay (LOS), morbidity, and mortality. For over 10 years at our tertiary care academic institution, advanced practice providers (APP) were responsible for performing all medicine admissions for private physicians, which equated to over 13,000 admissions in 2015. The heavy reliance on an APP for the admission encounter often led to variable delays in the initial physician evaluation and inadequate supervision of the advanced practice provider.

Purpose: To reorganize the admission process by prioritizing timely initial physician encounters for all medicine and telemetry admissions in an effort to optimize competency, efficiency, and to improve the quality of care delivered to our patients.    

Description: To help determine and guide staffing needs for the proposed encounter model, we obtained ED admission heat maps indicating the number of admissions per hour for each day. This information allowed us to approximate the number of additional hospitalists required for patients to be evaluated within four hours of admission. Hospitalist shift duration and start times were structured to align with hourly ED admission volume trends (Figure 1). The ED advanced practice providers were reorganized to provide comprehensive supportive patient care for admitted patients in the ED holding area and to the medicine wards. The hospitalist responsible for triage and distribution of patients was stationed in the ED to help bridge communication with ED physicians and APP’s, and to facilitate the identification of sick patients that needed to be evaluated promptly. Private hospitalists were expected to evaluate new patients admitted to them within four hours; if unable, then a hospitalist was assigned to perform the admission and a verbal handoff was given to the private hospitalist.   

Conclusions: Designating hospitalists to perform timely admission encounters maximizes the clinical expertise, efficacy and organization that is imperative in the delivery of high quality care. With the appropriate staffing in place, we anticipate this framework will result in many noteworthy and significant outcomes, including timely evaluation of admitted patients, decreased LOS and utilization, improved clinical and quality outcomes, and a better patient and family experience.

To cite this abstract:

Loukas, E; Kurian, LM; Kast, CL; Feldhamer, K; Karlin, CD; Belletti, L . THE DOCTOR IS IN: OVERHAULING AN ED ADMISSION PROCESS TO EMPHASIZE THE INITIAL PHYSICIAN-PATIENT ENCOUNTER. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 186. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/the-doctor-is-in-overhauling-an-ed-admission-process-to-emphasize-the-initial-physician-patient-encounter/. Accessed July 21, 2019.

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